A ‘Fat’ Conundrum
The human body is made from the simplest of starting materials—carbon, water, oxygen and nitrogen—assembled and organized into nearly infinite structural complexities. Of all our body's complexities, the seemingly simple fat is indispensible to life itself. It alone is responsible for compartmentalizing cells and organs, as well as insulating our neural network and preventing a biological ‘short circuit’. In other words, we are essentially kept alive by fats.
Lipid (fats) are essential for life support. Lipids provide biological energy to burn, protect internal organs, aid in nutrient absorption, and are the starting material for hormones and some vitamins. Lipids can be simple or complex. They come in a variety of forms, and are generally categorized into several families as fats, oils, phospholipids, sterols, triglycerides or waxes. No matter the family, all lipids share the same trait of insolubility in water and soluble in numerous organic solvents.
Several members of two very important lipid families—the simple lipid cholesterol (high density lipoproteins [HDL], low density lipoproteins [LDL], and related fatty acids), and triglycerides—a complex lipid, have been linked to an ever increasing list of health concerns.
Good Lipids Gone ‘Bad’
While the liver is capable of synthesizing all needed lipid complexes from plant matter, humans usually assist this natural process by indulging in gross excesses of commercially available fats.
There are predominantly four types of fats in the foods we eat. Saturated and trans fats (both of which are considered undesirable because of the way they are treated during assimilation) have been shown to raise low density lipoprotein (LDL) cholesterol (‘bad cholesterol’) levels in the blood; monounsaturated and polyunsaturated fats are not identified by our metabolic processes in the same manner, and do not appear to negatively impact LDL when consumed in moderation.
Excess calories (from fats, carbohydrates, and protein [to a lesser degree]) are all eventually stored as fat (adipose tissue). The cycle of hyperlipidemia (elevated serum cholesterol) begins with the synthesis of bile acid in the liver, from existing cholesterol, in response to caloric intake. As intake increases, more bile acid is produced. This material functions like an organic ‘soap’, forming a protective envelope around otherwise insoluble food fats (saturated and excess unsaturated fats), permitting digestion and assimilation. At the end of the cycle (in the ileum) they are ‘uncoupled’ (deconjugated) reabsorbed and recycled. This action increases the total amount of cholesterol in the blood plasma.
Storing of energy reserve is one of the body's ‘survival mechanisms’. Excess carbohydrates (simple/complex sugars) and protein not burned are all primarily converted to triglycerides and stored in fats cells. Excess of triglycerides in the plasma is called hypertriglyceridemia and is also linked to the occurrence of coronary artery disease.
Hyperlipidemia and Heart Disease
Elevated blood cholesterol (LDL and triglycerides) levels initiate arteriosclerosis and (potentially) hypertension. While it is not a universal association, hyperlipidemia is most often observed in conjunction with being overweight.
Data from the National Health and Nutrition Examination Survey (NHANES) completed in 2001-2004 showed that about two thirds of all adults in the United States were overweight and almost one-third was obese. According to a most recent cumulative study conducted by the CDC and NHANES, it was discovered that the number of cases of adult obesity has reach 68% (Ogden C L, Carroll M D, McDowell M A, Flegal K M; Obesity among adults in the United States—no change since 2003-2004. NCHS data brief no 1. Hyattsville, Md.: National Center for Health Statistics; 2007). The CDC has estimated that obesity is fast approaching tobacco as the top underlying preventable cause of death in the USA.
In 2000, poor diet including obesity and physical inactivity caused around 400,000 U.S. deaths, which is more than 16% of all deaths and the number two killer. That compares with 435,000 for tobacco or 18%, which is the top (self inflicted) underlying preventable killer.
In 2004, obesity mixed with inactivity increases the risks for the top two killers: all forms of cardiovascular disease (heart/disease and/or attack, cerebrovascular events—including stroke), and all forms of malignancies (National Vital Statistics Report, Volume 53, Number 5; October 2004.). As of 2004, the Journal of the American Medical Association listed ‘mistakes caused by the actions of health professionals’ the third leading cause of (preventable) death in the USA, beating out tobacco (Journal Of The American Medical Association; Starfield, B; 284(4):483-485; 2000).
In addition, hyperlipidemia and obesity are strong risk factors for hypertension (today more than 50 million Americans have hypertension), diabetes, kidney disease, gastric related disease, gallbladder disease, osteoarthritis, sexual dysfunction (ED), sleep apnea and other breathing problems.
The Statins Paradox
Presently, the number one drug in the pharmaceutical industry for antilipidemic action is the statin drug. This drug, created approximately 20 years ago, acts by inhibiting 3-hydroxy-3-methylglutaryl-Co enzyme (HMG-CoA reductase), the enzyme that leads to production of cholesterol. As production declines, a deficit in the total cholesterol pool forms causing the body to draw on its lipid reserves. The statin drug also has a second effect, it acts as an anti-inflammatory. Despite manufactures claims that HMG-CoA reductase inhibition is the primary reason for the cardiovascular benefit, there is now a growing body of evidence to suggest that it is not the case (Shovman. Immunol Res, 25(3); 2002).
Unfortunately this type of drug has a very negative downside. By blocking cholesterol synthesis, it directly causes the depletion of other key biological components downstream such as, ubiquinol (coenzyme Q10), creation and phosphorylation of various lipids, and muscle enzymes. Persistent muscle pain and weakness are the signs and symptoms of statin actions on these pathways. A review of the packing inserts for the most common statin cholesterol drugs available gives a list of the most common side effects that have been seen: unexplained muscle pain and weakness, headache, muscle aches, abdominal pain, muscle weakness, nausea, diarrhea, muscle inflammation leading to kidney failure, blurred vision, bleeding, dizziness, (etc.).
In addition, some researchers are now questioning the potential cognitive impact statins are having (Alzheimer's, dementia, and confusion), long and short term, due to direct inhibition of the brain's glial cell synthesis of cholesterol (Pfrieger. Science, 9 Nov., 2001; Muldoon. Am J Med, 108(7); 2000).
There remains a need for improved treatments for hyperlipidemia and/or weight loss.